Medical Billing Services in Texas

Texas runs one of the largest and most rule-dense Medicaid programs in the country, and Texas practices feel it in their billing: a state portal with its own claim logic, managed care organizations with their own variations, and one of the shortest Medicaid filing deadlines anywhere. Elite Bill Care provides medical billing services in Texas for practices from Houston and Dallas–Fort Worth to Austin, San Antonio and the Valley.

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Texas Medicaid: TMHP, STAR and the 95-day rule

• TMHP — the Texas Medicaid & Healthcare Partnership administers fee-for-service Medicaid; claims and eligibility run through TMHP systems with Texas-specific claim requirements.
• STAR, STAR Health and CHIP — most Texas Medicaid members are in managed care: STAR (acute care), STAR Health (foster care), STAR Kids and STAR+PLUS (aged/disabled and long-term services), plus CHIP. Major MCOs include Superior HealthPlan, Molina Healthcare of Texas, UnitedHealthcare, Blue Cross and Blue Shield of Texas and Cook Children's Health Plan — each with its own authorization and claims rules layered on the state's.
• 95-day timely filing — Texas Medicaid claims are generally due within 95 days of the date of service, materially shorter than commercial deadlines; our submission rhythm is built so Texas claims never age toward it (see claim submission).
• Enrollment — Texas Medicaid enrollment runs through TMHP's Provider Enrollment and Management System (PEMS); we manage it with your other enrollments (see provider enrollment).

Commercial and Medicare in Texas

Texas commercial volume concentrates in BCBS of Texas, UnitedHealthcare, Aetna and Cigna alongside large self-funded employer plans in the energy, tech and healthcare sectors. Our eligibility and authorization workflows are set up per payer and per MCO, and Texas Medicaid denials are appealed through TMHP and MCO processes with the state's complaint paths used when plans miss their own rules. See the full service set on our medical billing services page.

Choosing a medical billing company in Texas

When you compare medical billing companies in Texas, test them on the managed care map. Texas Medicaid billing runs through the Health and Human Services Commission, with TMHP — Texas Medicaid & Healthcare Partnership — as claims and enrollment administrator. Most members sit in STAR, STAR+PLUS, STAR Kids or STAR Health, with plans such as Superior HealthPlan, Molina Healthcare of Texas, Community Health Choice and Wellpoint varying by service area. Ask whether a company bills TMHP fee-for-service and each MCO under its own rules, and whether enrollment through TMHP’s PEMS system is tracked alongside credentialing.

Medicare and timing complete the picture. Medicare claims for Texas providers are processed by Novitas Solutions, Inc., Jurisdiction H. A medical billing company in Texas must also work to one of the tightest deadlines in the country: TMHP must receive in-state fee-for-service claims within 95 days of the date of service. The best medical billing services in Texas are the ones built around daily submission, so that deadline is never approached. Elite Bill Care works inside your own EHR and brings 10+ years of billing experience to that daily rhythm.

Frequently asked questions